Common causes of morbidity and mortality

BACKGROUND AND RATIONALE:

Malnutrition remains one of the most common causes of morbidity and mortality among children throughout the world. Approximately, 9% of under-five children suffer from wasting (weight for height below -2 standard deviations (-2SD) of the National Centre for Health Statistics (NCHS)/WHO reference values) and at risk of death or severe impairment of growth and psychological development.

Less than 2% children exhibit visible signs of malnutrition, however, an estimated 190 million under-five children are chronically malnourished, locked early into a pattern of ill health and poor development. This coupled with the rising under five mortality rate (>150 per 1000) in a number of developing countries, especially Africa-are grin testimonies to the devastating impact of malnutrition on families and societies.

Furthermore, in most of the developing countries, malnutrition is mutually reinforced by infections; both continue to assume an ever present and alarming threat. It has recently been estimated that problems involving interaction of malnutrition and infection still affect 3/4th of the world's inhabitants (greatly the under-fives because of the fledgling immune system) and account for majority of deaths. Not only can malnutrition lead to an increased susceptibility to infections, but also, infections can result in increased requirement for nutrients by hyper catabolism and increased losses of body constituents. Often, there is additionally a decreased dietary intake, and together, these can result in precipitation of acute deficiency states in the under-fives who are marginally compensated before the infections. A vicious cycle can be started, which if not promptly and properly treated, can result in death. To break this cycle is immunization. Immunization plays a vital role in protecting growth of the under-fives by preventing infectious diseases in them. Unfortunately for a number of reasons, one in five children in Nigeria are still not fully immunized against six major killer diseases of Tuberculosis, Measles, Diphtheria, Tetanus, Whooping cough and Poliomyelitis. Inadequate funding of health care in the developing countries is one reason. Failure of government to prioritise, lack of cross-sectoral collaboration and inability of weak health delivery systems to reach the entire population-particularly the most vulnerable and difficult-to-reach (people in rural areas)-are the other contributing factors.

The Millennium Development Goals (MDGs) state as the first goal "to halve between 1990 and 2015 the proportion of people who suffer from hunger." One indicator to monitor progress for this target is the proportion of children who are underweight - i.e. low weight compared with that expected for a well-nourished child of that age and sex. Child malnutrition is one of the measures of health status that the World Health Organization (WHO) recommends for equity in health. From the existing evidence it is clear that childhood malnutrition is associated with a number of socioeconomic and environmental characteristics such as poverty, parent's education/occupation, sanitation, rural/urban residence and access to health care services. Also demographic factors such as the child's age and sex, birth interval and mother's age at birth have been linked with malnutrition. The Nigeria Demographic and Health Survey 2008 dataset will be needed to prove the above points.

Therefore, there must be commitment and concerted action across many sectors of society to nick this menace called malnutrition in the bud.

STATEMENT OF THE PROBLEM

Good nutrition is excellent armour against diseases; yet this is circumscribed by poverty. Malnutrition and poverty have had an undeniable association since the earliest times of recorded history. Poverty increases vulnerability to malnutrition and diseases through limiting access to healthcare, information, education, safe water, sanitation, adequate diet and housing. This situation is often aggravated by the lack of knowledge, skills and resources necessary or the prevention and care of childhood diseases which drain nutrients from body and its cells.

No one would seek to deny the fact that poverty is a major cause of malnutrition and ill-health among the under fives. Furthermore, the power of good health is frustrated by lack of immunisation, muddled by faulty weaning practices and limited by constellation of infections. All these culminate in childhood malnutrition.

JUSTIFICATION

Malnutrition remains a major public health problem in many developing nations-Nigeria inclusive. It is one of the most common causes of morbidity and mortality among under-five children through out the world. Annually in Nigeria, an estimated 8000 children die from malnutrition before reaching four years. Since malnutrition leads to impaired mental and physical development of these children, it fundamentally constitutes impairment to the social and economic development of the developing countries. This has however persisted despite many strategies adopted to tackle it.

Previous literatures on surveys of nutritional and health status of under-five children in Nigeria are few and were mostly carried out in urban areas with little attention being paid to rural areas, leaving in total oblivion, the fact that Nigeria is a Sub-Saharan Africa developing country with about 70% of the population living in the rural areas. The 2008 Nigeria Demographic and Health Survey (2008 NDHS) has national representation covering both rural and urban settings; it is new and not yet explored by researchers specifically with respect to malnutrition in under-five children.

In addition, the under-five children are of particular interest because of the pronounced effects of malnutrition in them-malnutrition being a major cause of high morbidity and mortality in them. The most severe effects of malnutrition are concentrated in the under-five children that even, if nutrition improves thereafter they are likely to suffer from below-normal growth; affecting physical and mental development, thus compromising the future of these children and their nations. In the light of these, the importance of the aim of this study cannot be overemphasized.

AIM

The main aim of this study was to assess and determine the nutritional and health status of under-five children in Nigeria.